Vancomycin prescribing and monitoring guidelines for PICU

[Pages:2]PIER VANCOMYCIN GUIDELINES: neonates, infants and children

Table 1: NEONATES (under 1 month)

Corrected gestational age

Up to 33 weeks 33-44 weeks Greater than 44 weeks

Dose

Prescribe 15mg/kg every 12 hours* Prescribe 15mg/kg every 8 hours* Use dosing guidelines in Table 2

Monitoring: Target trough level = 10-20mg/L.

Request a trough level 1 hour before the 3rd dose (or 4th dose). Record blood sampling time on Equest form and administration chart. Do not delay giving the dose. Interpret the result of the assay before the following dose and adjust dose regime if indicated. See Table 3 for interpretation of levels and dose adjustment.

*If renal impairment or decreased urine output (12mg/L, reduce frequency; If level 90ml/min/1.73m2

B: Possible mild-moderate renal impairment

e.g. Rising creatinine, urea and/ or phosphate ; child requiring inotropic support; post-op cardiac surgery; history of renal impairment. Estimated creatinine clearance 50-90ml/min/1.73m2

Prescribe 25mg/kg LOADING DOSE to be given over 2 hr, followed by 15mg/kg every 6 hours (started 6 hours after the loading dose).

Monitoring: Request a trough level 1 hour before the 3rd (or 4th dose). Record blood sampling time on Equest form and administration chart. Do not delay giving the dose.

Interpret the result of the assay before the following dose. See Table 3 for interpretation of levels and dose adjustment.

Prescribe 15mg/kg every 8 hours

Monitoring: Request a trough level before the 2nd dose. Do not delay giving the dose. Check result before giving the 3rd dose.

This level is a SAFETY CHECK and should be interpreted with caution. For this level ONLY: - If level >12mg/L, reduce frequency to 12 hourly. If level 12mg/L, reduce dose to 10mg/kg every 12 hours. If level ................
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